MAINTENANCE OF CERTIFICATIONMAINTENANCE OF CERTIFICATION©©

G. Rainey Williams Surgical SymposiumG. Rainey Williams Surgical Symposium

Oklahoma CityOklahoma City

September 30, 2005September 30, 2005

American Board of Surgery American Board of Surgery

The American Board of SurgerThe American Board of Surgeryy

Allergy and ImmunologyAllergy and Immunology AnesthesiologyAnesthesiology Colon & Rectal SurgeryColon & Rectal Surgery DermatologyDermatology Emergency MedicineEmergency Medicine Family PracticeFamily Practice Internal MedicineInternal Medicine Medical GeneticsMedical Genetics Neurological SurgeryNeurological Surgery Nuclear MedicineNuclear Medicine Obstetrics & GynecologyObstetrics & Gynecology OphthalmologyOphthalmology

Orthopaedic SurgeryOrthopaedic Surgery OtolaryngologyOtolaryngology PathologyPathology PediatricsPediatrics Physical Medicine and Physical Medicine and

RehabilitationRehabilitation Plastic SurgeryPlastic Surgery Preventive MedicinePreventive Medicine Psychiatry & NeurologyPsychiatry & Neurology RadiologyRadiology SurgerySurgery Thoracic SurgeryThoracic Surgery UrologyUrology

MOC is an initiative of MOC is an initiative of the American Board of Specialties the American Board of Specialties

(ABMS) and its (ABMS) and its 24 member boards:24 member boards:

The American Board of SurgerThe American Board of Surgeryy

What is Maintenance of CertificationWhat is Maintenance of Certification©© (MOC)?(MOC)?

A process designed to document that diplomates of ABMS A process designed to document that diplomates of ABMS boards are maintaining the necessary competencies to provide boards are maintaining the necessary competencies to provide quality patient care. quality patient care.

Intended to provide more continuous evaluation of physician Intended to provide more continuous evaluation of physician performance than q 10 year “snapshots”.performance than q 10 year “snapshots”.

Developed by the ABMS and its 24 member boards in a Developed by the ABMS and its 24 member boards in a collaborative effort with a spectrum of medical and surgical collaborative effort with a spectrum of medical and surgical specialties and other organizations involved in health care specialties and other organizations involved in health care quality. quality.

The American Board of SurgerThe American Board of Surgeryy

Board Certification and Quality CareBoard Certification and Quality Care

The board movement was founded in 1917 out of The board movement was founded in 1917 out of concern for quality careconcern for quality care

Certifying boards set standards for qualityCertifying boards set standards for quality

There is evidence of a need for continued monitoring There is evidence of a need for continued monitoring and promotion of quality …and promotion of quality … ““To Err is Human,” IOM, 2000 To Err is Human,” IOM, 2000

• 44,000-98,000 Americans die yearly due to preventable errors44,000-98,000 Americans die yearly due to preventable errors

““Bridging the Quality Chasm,” IOM, 2001Bridging the Quality Chasm,” IOM, 2001• Health care system fails to translate knowledge into practiceHealth care system fails to translate knowledge into practice

The American Board of SurgerThe American Board of Surgeryy

1973: 1973: ABMS establishes a recertification policy for the continued ABMS establishes a recertification policy for the continued evaluation of competence; 1976 – ABS adopts time limited certifevaluation of competence; 1976 – ABS adopts time limited certif

1999: 1999: ABMS defines the General Competencies of a physician.ABMS defines the General Competencies of a physician.

2002: 2002: The four components of MOC are established to evaluate The four components of MOC are established to evaluate these competencies.these competencies.

2003: 2003: ABMS and member boards formally commit to evolve their ABMS and member boards formally commit to evolve their recertification programs into MOC.recertification programs into MOC.

2005: 2005: The American Board of Surgery begins MOC upon The American Board of Surgery begins MOC upon certification or recertification.certification or recertification.

History of MOCHistory of MOC

The American Board of SurgerThe American Board of Surgeryy

Physician Physician General CompetenciesGeneral Competencies

Medical KnowledgeMedical Knowledge

Patient CarePatient Care

Interpersonal and Communication Skills Interpersonal and Communication Skills

ProfessionalismProfessionalism

Practice-based Learning and ImprovementPractice-based Learning and Improvement

Systems-based PracticeSystems-based Practice

The American Board of SurgerThe American Board of Surgeryy

Four Components of MOCFour Components of MOC

1.1. Professional Standing Professional Standing

2.2. Lifelong Learning and Self-AssessmentLifelong Learning and Self-Assessment

3.3. Cognitive ExpertiseCognitive Expertise

4.4. Practice Performance AssessmentPractice Performance Assessment

The American Board of SurgerThe American Board of Surgeryy

Four Components of MOCFour Components of MOC

1. Professional Standing1. Professional Standing

Full and unrestricted medical licenseFull and unrestricted medical license

To be verified every three years following certification To be verified every three years following certification or recertificationor recertification

Reference letters from chief of surgery and Reference letters from chief of surgery and chair of credentials committeechair of credentials committee To be submitted every three years following To be submitted every three years following

certification or recertificationcertification or recertification

The American Board of SurgerThe American Board of Surgeryy

Four Components of MOCFour Components of MOC

2. Lifelong Learning and2. Lifelong Learning andSelf-AssessmentSelf-Assessment

Yearly CME of 50 hours, 30 in Category IYearly CME of 50 hours, 30 in Category I

Documentation of CME completion to be submitted Documentation of CME completion to be submitted every three years after certification or recertificationevery three years after certification or recertification

Self-assessment Self-assessment To be documented every three years after certification To be documented every three years after certification

or recertificationor recertification May be included in postgraduate CME or may be May be included in postgraduate CME or may be

independent efforts so long as CME attachedindependent efforts so long as CME attached

The American Board of SurgerThe American Board of Surgeryy

Continuing Medical Education (CME)Continuing Medical Education (CME)

Traditional passive lecture format of minimal impact in Traditional passive lecture format of minimal impact in changing practicechanging practice

Adult learning more effective if interactiveAdult learning more effective if interactive Learning at home via web potentially available for wide Learning at home via web potentially available for wide

variety of subjects – more convenient, cheapervariety of subjects – more convenient, cheaper Specialty societies need to develop material that is Specialty societies need to develop material that is

targeted to needs/focus of practitionertargeted to needs/focus of practitioner ACCME has not yet accommodated to change in ACCME has not yet accommodated to change in

methods of learning; no specific classification of self-methods of learning; no specific classification of self-assessment activitiesassessment activities

The American Board of SurgerThe American Board of Surgeryy

Self AssessmentSelf Assessment

Comprehensive self assessment in GS currently Comprehensive self assessment in GS currently available only via SESAPavailable only via SESAP

Ability of practitioner to self assess accurately currently Ability of practitioner to self assess accurately currently very limitedvery limited

ACS has recently added Surgical Index to online tools ACS has recently added Surgical Index to online tools and is considering adding Selected Readings in and is considering adding Selected Readings in SurgerySurgery

ACCME has not yet addressed self assessment as ACCME has not yet addressed self assessment as distinct from CMEdistinct from CME

Online learning coupled with self assessment offer Online learning coupled with self assessment offer possibility of more effective continuing education.possibility of more effective continuing education.

The American Board of SurgerThe American Board of Surgeryy

Self AssessmentSelf Assessment

Goal of evolving continuing education/self-assesment Goal of evolving continuing education/self-assesment is to develop activities which are most compatible with is to develop activities which are most compatible with usual learning routines of surgeonusual learning routines of surgeon

Classical lecture format CME is only one method of Classical lecture format CME is only one method of meeting requirements, and probably not the most meeting requirements, and probably not the most effective or efficienteffective or efficient

Flexibility in meeting CME/self-assessment Flexibility in meeting CME/self-assessment requirements will be the hallmark of new program.requirements will be the hallmark of new program.

The American Board of SurgerThe American Board of Surgeryy

Four Components of MOCFour Components of MOC

3. Cognitive Expertise3. Cognitive Expertise

Secure recertification examinationSecure recertification examination To be taken every 10 years after certification or recertification To be taken every 10 years after certification or recertification

(unchanged)(unchanged) While not presently planned, more effective outcome measures While not presently planned, more effective outcome measures

might eventually eliminate need for cognitive examination.might eventually eliminate need for cognitive examination.

The American Board of SurgerThe American Board of Surgeryy

Four Components of MOCFour Components of MOC

4. Practice Performance Assessment4. Practice Performance Assessment

Intent is to use outcome measures where available:Intent is to use outcome measures where available:NSQIP, TRACS, UNOS Registry, Cancer databases NSQIP, TRACS, UNOS Registry, Cancer databases

If national registry unavailable, participation in If national registry unavailable, participation in local/regional quality programs may applylocal/regional quality programs may apply

If none of the above, will require outcomes reporting by If none of the above, will require outcomes reporting by individual surgeon for 3-4 principal outcomes for 3-4 individual surgeon for 3-4 principal outcomes for 3-4 proceduresprocedures

ABMS currently developing assessment tools in two ABMS currently developing assessment tools in two areas: communication skills and patient safety. If areas: communication skills and patient safety. If effective, will be included in Part IV in futureeffective, will be included in Part IV in future

The American Board of SurgerThe American Board of Surgeryy

Potential Benefits of MOC for DiplomatesPotential Benefits of MOC for Diplomates

Improvement in actual and perceived quality of careImprovement in actual and perceived quality of care

More relevant and focussed self-assessmentMore relevant and focussed self-assessment

Acceptance by state boards for relicensureAcceptance by state boards for relicensure

Unitary measurement of practice performanceUnitary measurement of practice performance

Will reduce duplicate quality assessmentsWill reduce duplicate quality assessments

Potentially useful in pay for performancePotentially useful in pay for performance

? effect on malpractice costs? effect on malpractice costs

The American Board of SurgerThe American Board of Surgeryy

ConclusionConclusion

MOC is an evolving program which is targeted MOC is an evolving program which is targeted at more continuous measure of physician at more continuous measure of physician performance and more comprehensive performance and more comprehensive

assessment of multiple competencies. At assessment of multiple competencies. At present it is little different from traditional present it is little different from traditional

recertification, but it will change continuously recertification, but it will change continuously as more effective measures become available.as more effective measures become available.